Management of high-risk gestational trophoblastic disease.
Multimodality therapy with combination chemotherapy employing etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO), and adjuvant radiotherapy and surgery, when indicated, has resulted in cure rates of 80-90% in patients with high-risk metastatic gestational trophoblastic tumors. However, approximately 25-30% of high-risk patients will have an incomplete response to first-time chemotherapy or will relapse from remission. Most of these patients will have a clinicopathologic diagnosis of choriocarcinoma, metastases to sites other than the lung and vagina, more than eight metastases and/or failed inappropriate previous chemotherapy, resulting in very high World Health Organization scores. Salvage chemotherapy with cisplatin/etoposide, usually in conjunction with bleomycin or ifosfamide, as well as surgical resection of sites of resistant disease in selected patients, will result in a cure in most patients. New technology, such as the use of colony-stimulating factors to prevent treatment delays and dose reductions or high-dose chemotherapy with or without autologous bone marrow transplantation or peripheral blood stem cell support, may play an important role in the future management of patients who develop drug resistance.
Lurain
J R
JR
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois 60611, USA. jlurain@nmh.org
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D003609:Dactinomycin / Q000008:administration & dosage / Q000627:therapeutic use; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D005492:Folic Acid; D008727:Methotrexate